Inflammation is the foundation for cancer and degenerative/autoimmune diseases. Small changes in diet and exercise, e.g. omega-3 oils, vitamin D, low starch, and maintaining muscle mass, can dramatically alter predisposition to disease and aging, and minimize the negative impact of genetic risks. Based on my experience in biological research, I am trying to explain how the anti-inflammatory diet and lifestyle combat disease. 190 more articles at http://coolinginflammation.blogspot.com

Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:

Tuesday, April 13, 2010

Japanese Gain Ability to Digest Algal Polysaccharides from Marine Bacteria
Gut flora adapt to the food nutrients that are prevalent in different parts of the world. Bacteria able to digest unusual nutrients, such as the sulfated porphyrans found in seaweed eaten in Japanese cuisine, are also consumed along with algae. Formation of bacterial biofilms triggers the exchange of genes among gut bacteria and the acquisition of new polysaccharide-degrading enzyme activities.

Gut Flora Adapts to Diet
The million or so genes of the thousands of bacterial species found in the guts of humans around the world are adapted to the diet of each of those individuals. Each individual gut harbors a couple of hundred different bacterial species and those different types of bacteria increase or decrease in number in response to the composition of each meal.

Diversity of Plant Polysaccharides Provides Digestion Challenge
Plants provide the greatest challenge for digestion, because plants differ the most in their carbohydrate (sugars, oligosaccharides, polysaccharides) composition. Some of those carbs, such as sucrose, starch or the components of the plant cell walls, pectins, arabinogalactans and xyloglucans, are present in all vegetables. Whereas other polysaccharides, such as the sulfated porphyrans from red algae of the same name (Porphyra) are restricted to particular plants. Each different linkage and sugar requires a different digestive enzyme.

Gut Bacteria of Algae Eaters Have Algae-Degrading Enzymes
A recent report (see ref.) traced genes from marine bacteria that digest marine algae/seaweed, to gut bacteria of people who routinely eat seaweed. Researchers studying marine bacteria identified genes coding for new enzymes, porphyranases, that hydrolyzed porphyrans. When they checked gene databases for other porphyranase genes, they found that some gut bacteria had previously unassigned genes that were apparently, based on their nucleotide sequences, porphyranases. Curiously, these genes were only present in gut bacteria isolated from Japanese sources, i.e. from people who traditionally ate seaweed. In some of these bacteria there were more than 260 genes for degrading a huge variety of different plant polysaccharides.

Marine Bacteria on Seaweed Release DNA Incorporated into Gut Bacteria
Bacteria recognize that other bacteria are around by a process called quorum sensing. This signaling system triggers the production of matrix polysaccharides produced by the bacteria to hold the bacteria together in complex communities. Quorum sensing also mobilizes the release of copies of the bacterium’s genes, which is coordinated with uptake of DNA from the surrounding environment. [Note that the proteins that take in foreign DNA have basic amino acids arranged in the same heparin-binding domains that are also used by growth factors and their receptors or the numerous proteins that bind to nucleic acids in the nucleus or in ribosomes.] Thus, biofilm formation is accompanied by enhanced lateral gene exchange that would also enhance the incorporation of porphyranase genes from ingested marine bacteria.

Gut Bacteria Are Made in Guts and Shaped by Diet
Species of gut bacteria are defined in the micro lab by their ability to grow in Petri dishes of agar containing particular combinations of sugar, polysaccharides, etc. The sugars that different bacteria are able to metabolize for growth reflect sugars available as niches in different parts of the gut. Thus species are defined in part by the sugars and polysaccharides they can metabolize, i.e. by the enzymes they can produce.

In each human gut, however, bacteria of the species filling a particular niche will have many other additional genes than those that define the species. These atypical genes are present as a consequence of serendipitous encounters with genes from other bacteria (lateral gene transfer) and may reflect peculiarities of individual diets. Different regional cuisines also shape the regional gut flora. Persistent diet components would be expected to provide selective advantage for bacteria with genes capable of metabolizing new nutrients. Access to a rich diversity of bacterial genes to augment typical gut flora genomes will facilitate adaptation. Food processing to refine and simplify nutrient diversity, and hygiene to eliminate bacterial diversity in food, will reduce diversity in gut flora and minimize adaptation to novel foods. Antibiotics, especially persistent use, can permanently disrupt gut flora. Decreased diversity in gut flora may eliminate species of gut bacteria that are essential for normal physiological functioning of the gut and associated immune system, and may be major contributors to degenerative and autoimmune disease.

51 comments:

Nature connection has been lost during last few decades and at the same time autoimmune and allergy diseases have skyrocketed.

For proper immunity function adaptation and tolerance are very important. One (maybe the most important)way is through TLR system. Marine plankton/algae for example is able to activate innate immunity and thus also increase the activity and tolerance of immune system.

http://www.fasebj.org/cgi/reprint/20/12/2145.pdf

I think loss of proper tolerance for LPS is related to other chronic inflammatory diseases also.

This is a phenomenal post. I hope to see a whole series on this. But a couple questions.

Suppose the Japanese person who ate seaweed as a child comes to America and eats a very typical American diet, sans seaweed. How long will the gut remember how to breakdown the seaweed? There are many variables I am sure, such as antibiotic use and how frequently the person ate seaweed before stopping. But do you have any thoughts on how long your body holds onto the DNA that remembers a specific food?

Eating a wide variety of diets from around the world would mean that your gut would get exposed to many different molecules. Your gut would learn to utilize many different food types. But would this mean that your gut would be ok at breaking down everything, and good at breaking down nothing?

In other words does your gut learn to adapt to a varied diet at the expense of being able to specialize in a specific diet? Does this mean that German people should stick with German food? And Chinese people should stick to Chinese food?

It is common knowledge that, when people drastically change their diet to lose weight, they have a period of rapid weight loss and then usually their weight levels out at a weight that is often far short of their ideal BMI.

Do you think the gut flora adapting to a change of diet and becoming more efficient at digesting different foods could partially explain this phenomena?

Westie,I agree that LPS and other microbial components, e.g. fungal beta-glucan, are major inputs on chronic inflammation. In most cases, the source is just a common gut community member and the immune system should be tolerant and not over-react. Most of the diseases that I discuss on this blog are symptoms of malfunctioning tolerance and inadequate Treg function.

Blackflag,You bring up many interesting points. I think that many dietary phenomena are due to changes in gut flora.

I don't think that anyone has examined the impact of varied versus simple diets on the efficiency of digestion.

It is provocative that rosacea symptoms can be reduced just by increasing the transit rate of food through the bowel. That suggests that the products of the anaerobic metabolism in the colon bacteria (hydrogen, short chain fatty acids) contribute to facial inflammation. Sudden changes in diet can cause rosacea flares. It seems like changes in the gut flora can have big impact on the immune system.

Denny,I think that gut flora contribute to maintenance of the weight/fat set point. I think that it is easier to change weight after a major diet change and the gut flora will adjust to the new diet and increase digestive efficiency. Antibiotics, which totally disrupt gut flora, should also make weight loss easier, even though they contribute to disease.

In previous posts, I experimented with the Eades' 6 Week Cure diet and found it to function just as expected to provide an easy loss of ca. 10 lbs by switching to a carb free/high protein/high fat diet before switching again to a low carb diet for maintenance. I think that destabilizing the gut flora by changing diet is instrumental in this weight loss.

They (LPS, B-glucan etc.) have input in immunoactivation as a ligands for TLRs of course but what I have in mind is that TLR system might also be the main way to accuire tolerance for e.g. LPS.

Immune cells and cytokines makes inflammation not LPS.

Tolerance for LPS could be achieved with small amounts of LPS throught lymphnodes from the gut. Chylomicrons are the best candidates to make such a delivery for the immune cells through the lymphatic system.

Do you understand what I mean?

In chronic inflammation and autoimmune disease Th17 has interesting role which can be seen pathogenic. Tregs and Th17 seems to be somehow connected. High Th17 will lead to chronic inflammation and high Treg activity will lower the effect of inflammatory cytokines through for example IL-10.

One very important thing is that high Treg activity also protect cancer cells from the attack of the immune cells. Th17 cells does the opposite. They will kill cancer cells. Atleast in some cases Treg activity can be enhanced with PGE2.

In AD brain there is also increased PGE2 and Treg activity. In some animal models whole disease can be reversed with brain inflammation done by cytokine IL-6.

Dear Dr. Ayers,I have been diagnosed with rosacea and many people on various forums recommend your site. What are some general recommendations that you give to rosacea sufferers? Thanks a lot in advanceSusan

Dr Ayers as I stated earlier I deeply regret that you have accused me and the members of the Lyme Awareness Art Project of theft. I have been struggling with advanced Neurological Lyme Disease for 10 years and suffer debilitating and often agonizing symptoms. I make no money on the LAAP project. I pay for everything myself so money and profits do not play into this on my part at all. I spend much of the little energy I have linking people with Advanced Neurological Lyme to people who have information to offer them. A look at the long history of posts on the LAAP blog will show this to be truth. Those of us with Lyme are often too debilitated to do our own searches so having a site like LAAP where people can go and get links and information from one site has been of huge value to those that are very limited in mobility, and energy. All articles have the author in the title of the post and at the end with a link to the article. In the decade that we have been doing this we have never run into a problem however I can assure you that we are getting the word out there as fast as we can on every Lyme site, Facebook and Yahoo groups to delete the link to the Cooling Inflammation blog.

I assure you all of the titles to your posts clearly stated that they were written by you at both the top (in the colored title link) and the bottom and the tops of the pages. A few of us volunteers are working as fast as we can to update all of the sites with a message stating that you have requested the removal of all the links and quotes because you felt that LAAP had stolen the information. We give free permission to all Lyme related sites and professionals to help us get the links and voices out there, so no, I did not submit it to Well sphere but they may be grabbing LAAP’s blog as do many other sites. We are typing your demands for removal right on the original post page that way once all of the pages have been “crawled” by Google we can be sure the articles have all been removed. Every Lyme Group and Lyme website has been notified so if anything else shows up there are literally hundreds of thousands of eyes to catch it and we will promptly delete it. As I said I also struggle with Neuro Lyme but we will get this resolved as quickly as we can.

Linda,As you can read from my comments, I do not accuse LAAP of theft, but rather state that you do not quote from my articles, but rather print them in their entirety and then state in the title that they are from my blog. There are no quote marks or other indication that the words printed are mine. This gives false impression that you are providing a summary or analysis of my articles.

It is also unfair of you to construe that I am faulting LAAP by asking that my articles be removed. You are also doing me a disservice by eliminating all links to my useful blogs that could help Lyme sufferers, just because I caught you in an indiscretion.

I am so glad to have found this blog, what fabulous research and insights. I follow an anti inflammatory diet since being diagnosed with Relapsing Ploychondritis last year. I have not had a major flare since (only had the one anyway) but have lost of low grade inflammation. My dr's recommend azathioprine or steroids but am reluctant to take either for a myriad of reasons (I am a young mother and breastfeeding also).

I have read most of your blog in the hope of finding some info on LDN (Low Dose Naltrexone) and your opinion on it's use as a therapy for auto immune conditions. As I understand it is an opiate antagonist who's rebound effect stimulates an increase in endorphins which regulate T-cells.

Any opinion on this drug?

Thanks so much, I see you are a busy person so no worries if you can't get back to me on this one, I am happy just to read such a hopeful blog,

Claire (1),My understanding of relapsing polychondritis, is that it is an autoimmune disease attacking cartilage.

As you indicate, it is important that you reduce chronic, systemic inflammation as much as possible. Most people say that they are on an anti-inflammatory diet, but what they mean is the anti-inflammatory diets that are found in typical magazines, which are just inflammatory diets plus some veggies.

The fact that you mention lingering symptoms of inflammation, indicates that your diet is still probably contributing to your problem.

I will look up the info available on the typical cartilage protein that is the target in most polychondritis. That will just point back to other autoimmune diseases and ultimately to celiac or a viral infection. The disease can't start without chronic inflammation that is used based on diet.

First aid: You can probably reduce the attack on cartilage in particular areas by applying a general tissue anti-inflammatory, such as castor oil, caspsaicin or menthol. These don't penetrate, but that isn't important, since they work on your nervous system: trigger hot/cold nerve sensors to produce anti-inflammatory response in the surrounding deep tissue. It also works well on sore joints/tendons. Vagal stimulation should also work throughout your body.

Diet: Check your serum vitamin D level. I would expect that it is below 30. You will probably need more than 5,000 IU/day of vit.D3 supplement to get you into the 90 range. Check again after a month of supplements. Daily sunshine (never burn) over a large surface area will help a lot.

Celiac to Hashimoto's thyroiditis to vasculitis to RPC is one path. That means that you are likely to have an intolerance to gluten that got you started. That means that you should stop eating grains. Most diets are much healthier without grains anyway, because they also provide excess starch that just spikes your insulin and contributed to your problems.

Most nutritionists do not understand cell biology and only preach what their books say. They continue to preach moderate starch/sugar, when the biomedical literature says that depending on carbs for calories is unhealthy. Go to a low carb diet.

To be continued: out of space.

Good luck! There is a lot that you can do to help fix your disease. Let me know how you do.

continued:An anti-inflammatory diet is low in carbs and gets most of the calories from saturated fats. This is an simple diet that is also easy to stay on, since it is basically meat/fish/egg, with plenty of non-starchy veggies.

The other big area that is messed up in typical "anti-inflammatory" diets is the fats. Vegetable oils may be a big problem for you, since they are still mistakenly recommended by most dietitians. Eliminate all vegetable oils. Use only olive oil, butter or coconut oil. Saturated fats are your friends and do not try to reduce them. They are needed to stop inflammation when you are taking omega-3s. If I were you, I would start taking six fish oil capsules per day and check for reduction in inflammatory symptoms. If they haven't reduced, increase by four capsules per day. Repeat until the symptoms are gone. I only use fish oil supplements to check if symptoms are due to general inflammation. If they are, I try to address the source of the inflammation.

Make sure that you are not deficient in minerals, zinc, magnesium, iodine. They can get depleted during inflammation.

A major source of many autoimmune diseases is disruption of gut flora by a prior history of antibiotic use. Most sufferers will have abnormal bowel movements, because of inadequate gut bacterial growth, primarily in the colon. Pre- and probiotics will help. I recommend a whole milk-based live yogurt, supplemented with pectin and inulin.

Low dose Naltrexone: I think that LDN may be a good choice. It has been found to be useful in many different inflammation-based diseases, such as yours. Natural opioids may be involved in the topical anti-inflammatory treatments that I recommend, e.g. castor oil. LDN should work with the other general treatments that I have suggested.

Thank you so much! I'd love to see what you dig up on proteins re: RP.

I started following Datis Kharrazians diet protocol for Hashimotos (my friend helped him write his latest book so gave me much info). Days after my diagnosis I stopped eating all grains and refined sugars, and also dairy and starchy veg. I am still doing this. I ate lots of fish and meat and eggs: still getting symptoms and I read and article of a woman (with RP) who put herself into remission by turing vegan. Phew. That went against everything I had read (following Weston Price style of eating) but I thought what do I have to loose by trying it? That was at Christmas. I have eaten the odd bit of fish though. I just feel I need it. I am about to order some Krill Oil caps to replace the current Omega Zen ones I am taking.

My main source of fat seems to be coconut oil (organic cold pressed) and cocoa butter. The hardest thing for me with diet is that I LOVE chocolate. I made much raw chocolate with raw cacao butter, raw cacaos powder and agave nectar. But stopped after finding info on agave not being such a good sweetener. I have since stopped using cacao too and switched raw carob.

Claire,I think that the problem with your diet is low saturated fats combined with omega-6 fatty acids coming in with your seeds. With your low vit. D (and I would guess that it is only slightly higher with your conservative supplements and high inflammation) I think that adding omega-3 that are susceptible to oxidation in existing sites of inflammation has led to your joint pain. One of the signs that you inflammation is under control will be a higher response of your serum vit.D with added supplements. Getting vit.D from sun exposure will also be inefficient as long as your inflammation is high.

Unless you have a true allergy to milk proteins, I would recommend using dairy saturated fats as a significant part of your calories. Unless you have an ideological reason for going vegan or meatless, then I think that approach brings too many additional problems to make sense in your case. I see no reason to not be using fats from meat/fish/eggs/dairy as your major source of calories.

It seems clear to me that you need to alter your gut flora and dairy probiotics would be an easy source to shove it in the right direction.

You didn't mention prior antibiotic use or any gut problems. Constipation would be a sign of gut dysbiosis (inadequate gut bacteria.)

The only reason to cut back on chocolate would be the high sugar content. I wouldn't worry about modest amounts of chocolate as long as it hasn't been modified to include more omega-6 oils. It is a good source of saturated fats. Just eat semi-sweet and enjoy it. The fat content should make it less glycemic. I couldn't eat carob instead.

You will be able to tell when your inflammation starts to abate, because your symptoms will diminish. As long as your joints ache, your vit.D is low and your inflammation is still elevated.

Recently I was talking to a friend in Shanghai about gut biofilms. He has a researcher friend who lost weight by shifting his gut biofilms by going low carb (cutting out white rice) and adding barley and bittermelon which is known to lower blood glucoses. This researcher did not culture the stools as many of the species in the gut are interdependent. He sequenced all the DNA of the various species! *haa* It's anecdotal but I think very cool. Thought you might enjoy.

-G

P.S. In Broda Barnes MD book Thyroid The Unsuspected Illness, he observed that correcting hypothyroidism with replacement therapy resolves eczema.

I am on day three of 8-10 fish oil caps and feel less inflamed (my inflammation is not joint, rather I get trachea and pinna pain on and off). Do you think it's ok to take so many caps of fish oil regular, as a maintenance3 dose? Or would it be too blood thinning?

I keep reading opposing advice re: saturated fat, some say it's great in the absence of inflammation other that it causes inflammation. I feel I'd veer towards it, I cannot imagine traditional human eater spurning fat, yet i don't imagine they had auto immune conditions either!

I think that the global genomic studies of gut flora perturbed by various diets will be very revealing. It will also be interesting to watch gut flora as various diseases are treated.

I predict that a major culprit will be antibiotic use. Antibiotics for acne will give rise to a string of allergies and autoimmunity. Pediatricians treating with antibiotics and causing chronic ear infections will be shown to cause autoimmune and degenerative diseases. And it will all be mediated by gut dysbiosis. Inflammatory diets based on high carbs, low saturated fats and high omega-6 vegetable oils will fan the flames.

All will be revealed by monitoring gut flora and the immunological responses of the gut.

I think of the thyroid malfunctions as another symptom, like lowered serum vit.D, steroid hormones, blood lipids, of chronic inflammation. Treating the symptoms directly may be important for relief and also because of the inflammation caused by these symptoms, e.g. low vit.D is inflammatory. It will still be necessary to search for the initiating sources of inflammation.

Claire,I think that the biomedical literature is very clear on dietary fatty acids. There were some initial studies that suggested that saturated fats may contribute to disease, but those have now been refuted. Some omega-6 oils are needed, but most diets now have 10X more than is healthy and these vegetable oils are now a major contributor to inflammation based diseases. Omega-3 oils (EPA, DHA) are major contributors to health, but can cause problems when saturated fats are low.

I would say that a major contributor to autoimmune diseases is low saturated fat, seed-derived omega-6 oils and low vit.D.

I think that it is helpful to test for chronic inflammation by using fish oil to eliminate symptoms. I would not recommend continuing to use fish oil to reduce significant inflammation, although I don't think that it is a problem for blood clotting. Once you get your vit.D under control and increase dietary saturated fats, you can tell that your sources of inflammation have been reduced, because it will take less fish oil to suppress your cartilage-based inflammation.

Have you tried the castor oil to reduce your achy cartilage? Apply liberally to nearby skin and observe that the vagus nerve produces an anti-inflammatory reaction. Hot and cold should do the same thing. The temperature changes are only important on the surface.

Susan,Rosacea is not single disease and that makes recommendations for treatment difficult.

Rosacea involves the facial nervous and vascular system and is mediated by nerve stimulation or vascular inflammation.

Rosacea can also involve the gut and gut flora. Most of the immune system cells develop or are stored in the lining of the gut, and these processes are controlled by gut bacteria. Changing the gut flora changes the immune system and changes rosacea.

Rosacea treatments, such as antibiotics, can work through either the facial tissue, or through the gut flora. Antibiotics cause major disruption of gut flora that can become more or less permanent. This means that antibiotics also have a major negative impact on the immune system.

Since tolerance, i.e. controlling the immune system to minimize attack on self and on mundane food and common bacterial antigens, results from the development of immune cells in the lining of the gut, disruption of normal gut bacteria can lead to loss of tolerance to produce allergies and autoimmunity.

Since the foundation of rosacea is inflammation, then treatment will involve reduction of inflammation. Since most chronic inflammation is based on diet, then shifting to an anti-inflammatory diet as I outline at the top of this blog, should be a high priority.

Tolerating an anti-inflammatory diet is problematical for many rosacean, because their gut and gut flora are already damaged. Rehabilitation of the gut to produce normal bowel movements is an initial goal. This will be impossible while taking antibiotics.

Note that the anti-inflammatory diet also includes rectifying serum vitamin D. Most rosacean are chronically inflamed, which also produces low serum vit.D levels. Inflammation cannot be reduced until the serum vit.D has been elevated to 70-90 ng/ml. Vitamin D3 supplements can cause flareups, so the levels must be increased slowly.

Fish oil omega-3s would be expected to be anti-inflammatory, but in some rosaceans, they can also cause inflammation. The problem may be inadequate dietary saturated fats. Saturated fats are needed to trigger and produce bile salts for uptake of fish oil and fat soluble vitamins. Saturated fats are also needed to avoid oxidation of supplementing fish oil to produce inflammatory lipid peroxides.

So if you can tolerate the anti-inflammatory diet as I suggest, then you have a mild case of rosacea and you should be able to control it with vit.D and diet. If your gut is in worse shape, then you need to work on getting your gut healthy so that an anti-inflammatory diet works.

If the gut is no longer contributing to the flares or if treatment of the face directly is needed, then I would recommend trying some of the facial treatments that are provided by knowledgeable rosacean on support sites. I can only speculate on what might be effective.

The problem in the face itself involves inflammation that has not gone on to the normal resolution phase. Aspirin, acetylsalicylic acid, should be helpful if applied directly to the face, because the acetyl group of the aspirin can be transferred to COX-2 to produce a modified enzyme that converts unsaturated fatty acids into resolvins that can stop inflammation. Note that salicylic acid, that is commonly used in facial treatments, would not be effective in the production of resolvins.

Resolvins will also stop neutrophils from accumulating and causing problems during flareups. Mast cell release of histamines may also be a problem. I would recommend the use of mast cell stabilizers versus anti-histamines.

As for restoring gut flora, I like many other have taken antibiotics in the past so restoring my gut flora is my first priority at the moment. I have been taking a probiotic supplement by a company called Pure Encapsulations. Are there any that you specifically recommend?As far as the anti-inflammatory diet is concerned, I have two questions. How much meat is ok to eat in a week and are beans/lentils ok? I think you also mentioned in your blog that the Mediterranean diet is an anti-inflammatory one. I guess you mean minus the bread and pasta right? J I fruit in moderation ok? I tend to eat a bit of fruit in the morning, but then that’s it for the day. Maybe there is a book that you recommend that outlines the eating plan that you follow.I will make an appointment to check my Vit D3 levels in the near future. I bet they are quite low as a rosacean I tend to avoid the sun.What exactly do you mean by facial treatments?You say aspirin applied to the face can be helpful? Is there a cream that contains it or do you crush one up and make it to a paste and then apply it? Is this something to be done regularly to decrease redness?Finally I looked up resolvins and found out that it is made in the body in the presence of Omega 3. So that is not a supplement to take, if I understood correctly.Mast cell stabilizers is something that would be prescribed by a doctor and reduce flare-ups correct?

I also wanted to mention that my rosacea was induced by a cause of Accutane for acne three years ago. I do not know if that would change anything in your recommendations.

Thanks a gain for your recommendations, you have helped me a great deal already.

Dr. Ayers, Thank you so much for this blog, as it's answering a lot of questions for me about my own health issues, but I was wondering if you had an opinion on fructose malabsorption, the main issue I'm dealing with right now, with constipation. I'm convinced it's a gut flora imbalance problem but unfortunately some of the steps needing to be taken tend to aggravate the symptoms. I follow the FODMAP diet so fructans and most galactans are out of the question as well as sorbitol and xylitol. I've tried probiotics which exacerbated symptoms, as did l-glutamine. There's definitely inflammation going on, I have hidradenitis suppurativa, which appeared at the same time I noticed an issue with gluten/wheat, which stays in remission as long as I follow the diet, joint pain and tendonitis, both achilles tendons, which flares up within about 12 hours of eating something I shouldn't. The FODMAP diet is actually not far from an anti-inflammatory diet, with some tweaking, which I’m in the process of doing right now. I’m adding more good fats, eliminating the bad, eating a lot of leafy greens and colorful bell peppers, nuts, olives and olive oil, which I had been doing for some time already. I’m also gluten and soy free, about the only grain I eat is buckwheat, very little corn, potatoes or rice. I’ve increased the amount of fish oil-omega 3 I’m taking, slowly upping the D3, am taking zinc and turmeric.

It’s hard for me to pinpoint a specific moment that was the catalyst. I did take antibiotics a few years ago for a sinus infection but I can’t recall if that was a defining moment. I remember feeling better when I tried a low-carb diet a number of years ago and feeling worse when I stopped. What’s interesting though, is that the more problem foods I eliminate the less tolerant I become of them. It almost feels like I’m starving the bacteria so when I throw anything at it that it likes it now goes insane. What used to make me feel only mildly sick now makes me feel violently ill as well as almost hungover the following day, fatigued and depressed. I’ve had a hydrogen breath test, been biopsied for celiac (neither of which I trust for various reasons) and had a sigmoidoscopy, all of which came back as normal. I’m currently waiting to hear back from an academic hospital as to whether they’ll see me or not, and if not need to contact a different one. My GP wants the hospital to do all the blood tests, if I ever get in to see one, and the tests that I’ve had so far have all come back normal. I’m in the Netherlands where people tend to take a “wait and see” attitude and as nothing has turned up yet I think they’re starting to look at me like I’m crazy. Anyhow, if you would happen to have any insight I would be incredibly grateful to hear it. I’m kind of at wit’s end at the moment.

Susan,Pectin (apples) and inulin (leeks) should be helpful to feed your gut flora. The probiotics will be useful for only a fraction of the total 150 species of bacteria that you are missing because of your antibiotic treatments.

I think that beans and lentils are ok, but most of your calories should be coming from saturated fats. Meats/fish and whole milk, live yogurts should be helpful. Eggs are good. Grains are probably a problem. Use plenty of herbs and spices.

Accutane is very dangerous and should be reserved for very extreme, life-threatening cases. I think that it kills off stem cells and causes permanent damage. Rosacea needs to be avoided by preserving the gut flora and immune system during treatment. Most treatment causes more damage than it fixes.

Facial treatments or anything that is applied to the face to treat flares, is an art form. Tolerance of rosaceans differs greatly. Some use sulfur and salicylate. Direct treatment of the face is very complex and empirical, because the underlying physiology is very abnormal in many cases.

I suggested acetyl salicylic acid (aspirin) because of its special chemical properties and unusual way of interacting with COX-2. I think that there are some commercial creams, but most use salicylates instead, and that is an entirely different chemistry. Resolvins are not commercially available.

Rainarana,Constipation is the big clue. Constipation indicates dysbiosis, or inadequate gut bacteria. I think that your gut bacteria has been very reduced by antibiotics and never returned to normal.

It is difficult to reestablish gut flora, because diverse bacteria are needed for digestion of complex foods. As you have observed, as you restrict your diet to avoid problems, then you are less able to handle different food, because you have reduced the bacteria that you need.

It seems that solving lactose intolerance provides a model. Lactose intolerance is just a lack of lactose metabolizing bacteria. In that case, just eating lactose with probiotic bacteria, which are lactose metabolizing, changes the gut flora and eliminates lactose intolerance.

The problem that you have, is getting the bacteria that you need. Hygiene contributes to the problem, because it eliminates all of the sources of the biological diversity that you need. Processed foods are also a problem, because they lack the small amounts of diverse carbohydrates that are needed to maintain the hundred + species of bacteria in a healthy gut.

It is going to be uncomfortable for you to reestablish your gut flora, because you will have to persist as you slowly get back to normal. These are not food allergies.

Vegetables/fruits with pectin and inulin should help. Unprocessed foods with lots of complexity in herbs and spices are the goal.

You haven't mentioned meats/fish/eggs/dairy. Saturated fats should be the major source of calories. The saturated fats will probably also decrease inflammation in response to fish oils.

thanks again for your reply. Do you think that me taking Accutane could have depleted my VIT D3 stores or caused inflammation that than lead to my rosacea symptoms?When you say it kills stem cells is there anything that can be done? Obviously I regret taking the medication and have a hard time coping with that I am now worse foo that before. But I am happy to have found your site.Do you think that with the anti-inflammatory diet, healthy gut flora and upping VIT D3 i will notice improvements. I certainly hope so...Is there any other measures besides probiotics/ prebioitcs to have a healthy gut flora? Any books you recommend on the anti-inflammatory diet?Thanks again

Susan,I have a profound respect for the body's ability to regenerate and I think that most damage can heal. I did not mean to be pessimistic about returning to health, because I think that it is very reasonable. It is just not a matter of taking a drug and it does not just involve the face. It is also not just a matter of avoiding triggers (as is also incorrectly recommended as the solution to allergies.)

Rosacea is poorly understood medically and gut flora and their contribution to immunity is just beginning to be studied. Most of the earlier treatments were very short sighted and damaging.

That said, I am very optimistic, because many simple, cheap cures to rosacea have not been attempted. Rosacea becomes more complex and harder to treat as it develops, so it is obvious that early effective treatments with a minimum of drug use will be the ultimate answer. This is also why dermatologists are not pursuing a cure.

I think that there are many useful anti-inflammation books on the market with plenty of dietary suggestions. I have minor arguments with each, but share most of their overall goals.

I think that the typical thinking that comes with being bombarded with increasing triggers, is to pull back and simplify everything, but the answer to rosacea seems to be to slowly move in the opposite direction. Emotional triggers, exercise, sunshine, foods, bacteria, all seem to trigger flares, but avoidance exacerbates rosacea. Gut flora need to be supplemented from innumerable sources, so clean, processed food eliminates the needed microbial diversity and leads to a diminished gut flora and a dysfunctional immune system. Exercise is a potent anti-inflammatory and is essential for connective tissue integrity. Sunshine is needed for optimal vit.D and probably also stimulates anti-inflammatory nerve signaling. All of these are problematical for rosaceans.

The point is that rosaceans would benefit from aggressively normalizing their lives, but that is the opposite of the mental state of a rosacean, since one of the symptoms of chronic inflammation is depression.

It seems to me that rosaceans would benefit most from being treated, but medical caretakers are frustrated because they do not have effective treatments and they don't understand the disease.

The bottom line is to establish a foundation for healing, by fixing the gut flora and having normal bowel movements. This will mean eliminating antibiotics, using probiotics and prebiotics (fruits and veggies with pectin and inulin), increasing diet complexity with saturated fats as the major source of calories instead of starch/sugar. This means a wide variety of meat/fish/eggs/dairy and veggies. Eliminate vegetable oils -- use butter, olive oil or coconut oil. This is the opposite of processed foods and should be changing with the seasons to enhance variety in polysaccharides and thereby gut flora.

Dr. Ayers, your blog is very interesting to read. You focus a lot on an anti-inflammatory diet. I am interested in nutrition and am sometimes confused by the information you read, low fat, low card, vegan, etc...But your diet makes sense. I read more and more that it is not the saturated fat that is to blame for cardiovascular disease. I do have some questions though.1. Fiber is critical for good health and especially for healthy bowel movements. I wonder if someone would get enough fiber on a diet outlined in your blog. Fish, dairy, eggs, meat all have 0 fiber.2. I do not know if you have recipes or meals plans somewhere, but maybe readers of your blog would like that to know how to follow such a diet. I certainly would appreciate it.regards

Monica,I try to just extend what the biomedical literature actually has studied and apply it to diet to explain disease and lead to health.

At the top of the blog page is a link to a summary of the Anti-Inflammatory Diet that I suggest. Veggies are there to support development of healthy gut flora and to provide phytochemicals.

Most of the calories come from saturated fats, because the literature shows that saturated fats are safer for heart health. (Unsaturated vegetable oils are much more profitable for the ag industry and are encouraged for economic reasons, although they are highly inflammatory.)

Leafy and/or non-starchy vegetables provide complex polysaccharides, fiber and phytochemicals. Starch causes a rise in blood sugar as fast as any simple sugar and should be classified as a simple sugar for health purposes. Fiber is just complex polysaccharides that are degraded in the colon. Stool volume and hydration comes from gut bacteria and not directly from fiber.

A diet without meat/fish/eggs/dairy is typically less healthy, because it relies on grains/carbs for calories and is usually inflammatory. The biomedical literature does not support vegetarian diets as healthier.

Most low carb diets that focus on saturated fats as the major source of dietary calories would be consistent with my diet suggestions.

There are more than 160 articles on this site, so use the search (upper left), the index, lower right or the article by date to locate those that interest you.

Dr Ayers, thank you so much for your reply. Thinking about my eating patterns over the last few years I think that by following the generally accepted “healthy eating” advice I was doing even more damage. I was out of work most of 2006 with a badly herniated disc in my neck, which was eventually replaced, but in the time up until then I was also taking a lot of pain medication, narcotic and NSAIDs, which I’m sure didn’t help. After I recovered from the surgery I worked on getting back in shape, which meant lean meats, a lot of fruit and veg, oats, heard about agave syrup and tried that but found it made me feel worse and then one by one fruits had to be eliminated. At some point lactose became a problem, which was actually the first thing to go, then grains, then fruit and then assorted veg. Light bulb moment . . .

I do still eat small amounts of blueberries. I was using grape seed oil for cooking but have switched to olive oil and butter, started buying grass fed or free range meat and eggs. I use lactose free milk (half fat as I prefer it in my coffee) and cream cheese (double cream). I’m not a big egg eater but have started adding boiled egg to my salad of either spinach or mixed greens, (not green) bell pepper, some kind of meat, sunflower seeds, parmesan cheese with oregano and olive oil, having a soft boiled egg with lunch on the weekends. Dinner is meat and some kind of veg. I’ve been trying to eat more fatty fish but getting my husband to agree can be difficult. And wild game, I haven’t eaten much lately but semi-regularly eat deer, duck, ostrich, kudu, springbok. Breakfast lately has been whole buckwheat groats with milk, butter, fresh blueberries, cinnamon, shaved almonds and sunflower seeds, coffee with milk. Snacks are any of the following: macadamia nuts or cashews, green olives, buffalo mozzarella, almond meal muffins. And I drink water or coffee with milk. I’ve been trying to force myself to drink green tea, can’t stand tea so I let it cool off enough that I can gulp it without tasting it for too long. I haven’t eaten much processed food in years aside from the occasional GF cookie or chips, even less now.

Is it best to start with dairy, slowly reintroducing foods? You mentioned somewhere eating non-pasteurized yoghurt. This would contain the probiotics necessary? Being in Europe this wouldn’t be a problem to find. I’ve seen goat and sheep milk yoghurt as well. I love sheep cheese and have had the yoghurt once with fruit, although I’m assuming plain would be best. Does milk from different animals make a difference? I’m going on holiday on Thursday, I hope, if the volcano quiets down, so introducing new foods will be after that as I don’t want to be miserable during my vacation. But then it will be warming up and I have lots of loose fitting clothes to make room for WWIII in my bowels and will be putting in an herb garden again this Summer, some veg as well.

This probiotic topic interests me a lot. I still cannot tolerate dairy without bloat/acne and I suffer constipation. I eat paleo, around 60-70% fat and the rest carbs and protein.

I started having a cup of strained goat yogurt every evening hoping to get my bacteria flowing. It lists live active culters after goat milk as only ingredients. I have sauerkraut a couple times a week. I am in love with the sun and try to be outside like 24/7 but I tan VERY EASILY so I assume I don’t absorb as much.

I am curious about the length of time it should take to reflourish my gut. Also, if I have low stomach acid from years of massive coffee intake, massive artificial sweetners and diet soda and smoking how this low acid will effect my gut flora. On top of this bad diet, I exercised obnoxiously and was anorexic(lifelong illness but I am not actively anorexic”) for close to 5 years before seeking treatment. I am weight stable now, but totally unhealthy digestionwise.

Would probiotics or HCL be beneficial to try and help my body processing and digesting food?

Dr. Ayers, thanks for the reply. So the diet you suggest is very similar to an Atkins type diet? I am just wondering about a couple of things that maybe you would like to comment on.1. Doesn't a high intake of meat negatively impact bone health, as a high protein intake increases the excretions of calcium?2. Some argue that we are not designed to consume animal flesh, as we have long intestines and meat takes about 72 hours to fully pass through us. That is why it has been linked to colitis , diverticulitis and colon cancer.3. I suppose that the diet you suggest is for health and longevity, however, when they studied the longest lived cultures, almost all of them lived on a plat based diet and did not eat a lot of fish or meat.I#d be very interesting to hear your thoughts on this.I enjoy your blog a lot.Regards, Monica

Dear Dr. Ayers,great blog. After having read a lot of your posts I decided to start following an anti-inflammatory diet/lifestyle.Lunch and dinner is easy as I usually have a piece of organic meat or fish with vegetables or salads.I also occasionally eat tofu or tempeh. Anything wrong with that?I have bought fresh watercress today from the farmer's market and had it with a piece of baked chicken. YumAnyways I have a slight food intolerance to eggs, so I should not eat them every day, but I really like them for breakfast.Do you have any other suggestions for breakfast? Is a quinoa/buckwheat/ steel-cut oats porridge ok with yogurt to slow the insulin response?Thanks already for your response.

1. "Doesn't a high intake of meat negatively impact bone health . . .?" No. See http://jcem.endojournals.org/cgi/content/full/89/3/1169. Also, Dr. Ayers (and most other paleo/LC types) advocate a diet high in saturated fat, NOT high in protein.

2. "Some argue that we are not designed to consume animal flesh . . ." Wrong. Humans are omnivores, fully adapted to eating meat, as well as plants in lieu of meat. Our intestines are longer than a pure carnivore's but shorter than an herbivore's, and we don't have the multiple stomachs typical of herbivores. For other similarities between humans and carnivores, and difference4s from herbivores, see http://www.second-opinions.co.uk/carn_herb_comparison4.html.

3. "when they studied the longest lived cultures, almost all of them lived on a plat based diet and did not eat a lot of fish or meat". Really? See http://donmatesz.blogspot.com/2009/12/high-dietary-animal-protein-links-to.html.

Thanks for your comments and giving me some hope. I have read now a big part of your blog posts, although I do not understand all of it as I am lacking the medical background.I will follow your anti-inflammatory diet, get my VIT D3 tested and supplement if need be(I highly suspect so). I will also try to get my gut as healthy as possible. Are enemas necessary?I will also try to adapt an exercise routine and get some sun, you are absolutely right that rosecans tend to avoid these two as they seem to worsen the symptoms. But ultimately they make you feel better in the end. When you say that exercise and sunshine is problematic for roseacans you do not mean to avoid them, correct?If I supplement with D3 I will not need additional VIT A as I took Accutane, right?Please let me know if there is anything else to add or anything I should get tested for. I am sorry if I like thins simplified, but these is just how I tend to understand it best.I really hope that this will improve my quality of life and hope to be able to contact you if questions arise. So far doctors told me that there is not much they can do for me, so hearing that there is a chance of improvement is great.susan

Malpaz,Constipation once again. As you guessed, that means you have killed off most of your gut flora. Anorexia and smoking with a soft drink chaser is guaranteed to wreck havoc with gut flora.

If you do in fact have low stomach acid, one obvious cause is Helicobacter pylori infection. Trying to add acid doesn't work, because HCl is not made directly in the stomach. Most people actually control H. pylori with the phytochemicals that they ingest with veggies, herbs and spices.

Live yogurt, pectin (apples) and inulin (leeks) should help to build up your gut flora. It will takes persistence and tolerance of gut discomfort, until you reconstruct a functional combination of bacteria. You need to eat many different kinds of veggies until you get a stable combination. That is just the opposite of anorexia.

It will require persistence to produce slow progress. The goal will be more normal bowel movements. You should regain lactose tolerance and gradually improve your tolerance of other foods.

Expand your paleo diet to include meat/fish/eggs/dairy and plenty of low starch veggies. Whole fruits should be ok. Smoking is ridiculously unhealthy. It killed my father (cancer and heart disease), so I can only condemn it as the anti-life.

Good luck. Let me know how you progress and check out the rest of my suggestions for an anti-inflammatory diet and lifestyle.

Alex,I would say that the worst meal to choose for starchy grains, such as oatmeal, would be breakfast. I think that carbs for breakfast is a recipe for chasing elevated insulin and hunger for carbs all day.

Check into what the rest of the world eats for breakfast and pick some with veggies/meat/eggs/dairy. I typically eat stewed tomatoes (it is hard to get it out of a can without lots of sugar/HFCS), fresh chives, olive oil and a poached egg, or eggs and sausage. Stewed tomatoes and meat or fish would be very tasty. Adding herbs and spices is great. You can have both pectin and inulin by stewing up some tomatoes and leeks.

Let me know what you come up with for a tasty low carb, high fat breakfast to start the day right.

Caphuff,Thanks for jumping in where I fear to tread on the relative virtues of carnivore vs. herbivore vs. omnivore.

I am amazed that vegetarian diets are given a pass with respect to evaluation of deficiencies, disease and life expectancy. My reading of the med. lit. is that most is myth, just as most of the prevailing nutritional recommendations.

Susan,Sun is hard on rosaceans, because of hyperpigmentation. I don't know what happens if the sun is shined where it normally doesn't, e.g. backs of legs. I don't know what the lasting impact of accutane is on subsequent vitamin A supplementation. I don't have a clue about enemas. Some people swear by them, but I find them too disruptive without providing replacement bacteria of sufficient complexity. ?

I think that the secret with all things rosacean, is to proceed cautiously and learn your limits, but be persistent. Try to be aggressively anti-inflammatory, but do not overstep into causing flare ups.

Don't expect progress without some failures. It should be pleasant to record some control and progress. Let me know of your successes and failures.

Westie,I have failed to comment on tolerance to LPS. It shouldn't be possible, since LPS and beta glucan interact directly with receptors of the innate immune system. I guess the point is that overall control of inflammation should keep the responses to bacterial components at a functional level, so that they don't result in excessive accumulation of neutrophils, etc. in tissue, e.g. rosacea.

Dr. Ayers,There seems to have been a flurry of activity regarding the use of magnesium stearate in supplements. Mercola for one is saying that magnesium stearate may encourage the formation of biofilms.I note that my 1500mg glucosamine sulphate tables contain it. Also vitamin D3 gelcaps contain it.Do you have any advice from your experience?

Bill,Magnesium is not going to be good or bad, it is simply powerful and essential.

I caught myself pondering a bag of magnesium sulfate yesterday. MgSO4.7H20. Note the waters of hydration, i.e. water tightly bound in the lattice of the crystals by hydrogen bonding. This is an extreme example of why magnesium is important in biofilm formation.

Biofilms are held together by acidic polysaccharides elaborated by bacteria that have been triggered by quorum sensing. Those acidic polysaccharides have carboxylic acids (-COOH) that provide electron pairs and a hydrogen atom with its electrons polarized to one side, the components needed for hydrogen bonding.

Magnesium readily loses two electrons and can therefore bond to the localized electron pairs provided by the carboxylic acids of acidic polysaccharides. Magnesium can bind and cross-link two polysaccharide strands to give the biofilm matrix rigidity.

In cells, magnesium binds even more strongly to phosphates, e.g. ATP and nucleic acids, and is required for the shape of these molecules that is recognized by enzymes. Thus, adding EDTA to solutions of DNA can remove magnesium from the DNA, change its shape and prevent DNAses from degrading the DNA. The magnesium-depleted shape of the DNA does not bind to enzymes.

Sulfated polysaccharides, e.g. heparan sulfate, form the strongest hydrogen bonds and always dominate competitions for binding to magnesium and to proteins that bond to nucleic acids. Hence heparin, the most intensely sulfated polysaccharide, can be injected into cells to stop binding of proteins to IP3. Heparin is also imported into newly fertilized eggs to strip off the small, basic packaging molecules that were used to condense the DNA chromosomes in the heads of sperm, and the chromosomes can be reconstituted in an active form with histones.

So, the question was very complex, but the answer is that magnesium and probably zinc are needed for the function of biofilm polysaccharides and by extension for bacterial proteins that bind to the biofilm matrix. Biofilms are essential for health and biofilms are attacked and exploited during pathogenesis. Biofilms are the source of signals for gut immune system development. Biofilms are also attacked in the small intestines by the heparin that is released from mast cells.

I have been reading your blog with great interest for the past three months. I am trying to weigh the risks of infection versus prophylactic antibiotic use. I wonder whether you feel any inclination to help me with this decision. I have mitral valve prolapse. My family doctor, who is married to the head of cardiology at the local hospital, prescribes a large single dose of broad spectrum antibiotics (erythromycin) one hour before my dental cleanings to prevent any bacteria from infecting my heart. I am in my early 40s and in relatively good health. My gums never bleed when I floss (but I do bleed during the mercenary dental cleanings). I seem to experience gastrointestinal problems for months following the large dose of antibiotics. Do you know, or can you surmise, how detrimental the large (4 pill) dose of erythromycin would be to my gut flora? I have spoken to my doctor, but she believes this is a necessary precaution. My dentist will not perform my cleanings without assurance that I have taken the antibiotics. I tend to put off my dental cleanings because I fear the long-term effects of these bi-annual assaults with antibiotics on my health. I don’t know how to weigh the risks. I’d appreciate any information you can give me to help me decide what to do.

Hey Dr. Ayers, I have been reading through most of your blog and I find it very fascinating and informative. Recently I had a stool test done which revealed I have a gut dysbiosis. I am not producing any beneficial lactobacillus bacteria at all but have a +4 for other beneficial bacteria, and a potential pathogen, from the Bacillus Species. The test showed my yeast levels were under control, but I am wondering if candida could still be a culprit. I suffer from dandruff, jock itch and a stubborn toenail fungus.

Anyways I have scoured the internet for solutions to my problem and everywhere I go I find different and conflicting information. I have tried following a very limited diet for 4 months, limiting myself to low-carb veggies, meat and fat, with no fruit, nuts or dairy consumption. My macro nutrient ratio followed the same outline as the Optimal Diet. But I don't know if what I am doing is helping.

Last week I began consuming probiotics and added back a little starch into my diet, after reading its benefits from The Perfect Health Diet book, but I have yet to feel any improvement.

I am currently eating a variety of cooked and raw veggies, with the occasional sweet potato, lots of meat from grass-fed animals, lots of sardines and salmon, olive oil, and lots of coconut oil. What do you recommend I do? Is there a possibility I have candida, and if so, should I restrict my diet from...basically everything.

I am also supplementing 5000IU of Vitamin D, began last week, and taking fish oil.

Dr. Ayers,I had my Vit D tested last year and it was 61. What is the recommended level? I have seen various numbers. Also is Agave Nectar worse than HFCS and should not be used? Thanks for all the information you supply on your blogs. I try to read them all.

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About Me

I grew up in San Diego and did my PhD in Molecular, Cellular and Developmental Biology (U. Colo. Boulder). I subsequently held postdoctoral research positions at the Swedish Forest Products Research Laboratories, Stockholm, U. Missouri -Colombia and Kansas State U. I was an assistant professor in the Cell and Developmental Biology Department at Harvard University, and an associate professor and Director of the Genetic Engineering Program at Cedar Crest College in Allentown, PA. I joined the faculty at the College of Idaho in 1991 and in 1997-98 I spent a six-month sabbatical at the National University of Singapore. Most recently I have focused on the role of heparin in inflammation and disease.